For people released from prison with controlled HIV infection, a comprehensive package of support including individual counseling, rapid linkage to community health care, and cell phone medication reminders, was not effective in preventing loss of HIV suppression. Researchers at the University of North Carolina at Chapel Hill and Texas Christian University compared the levels of HIV in the blood of 405 people randomized to the multidimensional intervention or to standard care. Six months after release, only approximately 60 percent of people in both study arms maintained undetectable blood levels of HIV. The inability of the intervention to prevent loss of control of HIV means other factors, such as access to housing, a job and a support system, were likely at work and impeded a person’s ability to control their HIV infection upon release from prison.
These findings were published in the Journal of Acquired Immune Deficiency Syndromes in May. Read the NBC News coverage of the study’s results.
“The results make it clear to us that the question is not how do we teach the salmon to do a better job swimming upstream, but how do we reduce the force of the current that is pushing so hard against them,” said study co-author David Wohl, M.D., a professor of medicine in the UNC School of Medicine’s Division of Infectious Diseases. “We are learning that there are powerful social forces like racism, poverty, mass incarceration and substance use that stack the odds, and barriers so high that successful community re-entry becomes incredibly difficult.”
By the end of the six month study, nearly 40 percent of the study participants had a detectable viral load, were lost to follow up or were incarcerated again. A detectable viral load not only impacts the health of the person living with HIV, but makes them infectious.
“We know people living with HIV must keep their virus suppressed to preserve their personal health,” said Carol Golin, MD, study co-author and associate professor of medicine and health behavior at UNC. “Beyond that, studies also show that keeping the viral loads of people living with HIV undetectable is critical in preventing further spread of HIV to vulnerable communities and in ending the epidemic.”
During qualitative interviews with study participants, many admitted to crashing on friends’ couches or living on the streets.
“Nearly all of the releasees interviewed in one substudy faced substantial barriers to getting a job because of their history of incarceration,” Golin explained. “Many talked about how their lack of employment, insufficient income, unstable, stressful living circumstances, and mental illness competed with their medical needs.”
Wohl and Golin believe that the inability to get basic needs met can prevent former inmates from focusing on their health.
“There is a paucity of resources that exist in HIV and prison communities,” Wohl said. “This is a wake-up call for the infectious diseases field. We need to be thinking about how we can build healthier, safer and more supportive communities for inmates to enter upon release, rather than just more motivated prison releasees.”
The UNC School of Medicine and Texas Christian University teams also collaborated with the Division of Infectious Diseases at the University of Alabama School of Medicine. This research was funded by the National Institute of Drug Abuse at the National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.